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Published in: World Journal of Surgical Oncology 1/2008

Open Access 01-12-2008 | Case report

A multidisciplinary approach for the treatment of GIST liver metastasis

Authors: Pejman Radkani, Marcelo M Ghersi, Juan C Paramo, Thomas W Mesko

Published in: World Journal of Surgical Oncology | Issue 1/2008

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Abstract

Background

Advanced gastrointestinal stromal tumors (GISTs) can metastasize and recur after a long remission period, resulting in serious morbidity, mortality, and complex management issues.

Case presentation

A 67-year-old woman presented with epigastric fullness, mild jaundice and weight loss with a history of a bowel resection 7 years prior for a primary GIST of the small bowel. The finding of a heterogeneous mass 15.5 cm in diameter replacing most of the left lobe of the liver by ultrasonography and CT, followed by positive cytological studies revealed a metastatic GIST. Perioperative optimization of the patient's nutritional status along with biliary drainage, and portal vein embolization were performed. Imatinib was successful in reducing the tumor size and facilitating surgical resection.

Conclusion

A well-planned multidisciplinary approach should be part of the standard management of advanced or metastatic GIST.
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Literature
1.
go back to reference Gold JS, DeMatteo RP: Combined surgical and medical therapy, the gastrointestinal stromal tumor model. Ann Surg. 2006, 244: 176-184. 10.1097/01.sla.0000218080.94145.cf.PubMedCentralCrossRefPubMed Gold JS, DeMatteo RP: Combined surgical and medical therapy, the gastrointestinal stromal tumor model. Ann Surg. 2006, 244: 176-184. 10.1097/01.sla.0000218080.94145.cf.PubMedCentralCrossRefPubMed
2.
go back to reference DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF: Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000, 231: 51-58. 10.1097/00000658-200001000-00008.PubMedCentralCrossRefPubMed DeMatteo RP, Lewis JJ, Leung D, Mudan SS, Woodruff JM, Brennan MF: Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg. 2000, 231: 51-58. 10.1097/00000658-200001000-00008.PubMedCentralCrossRefPubMed
3.
go back to reference Langer C, Gunawan B, Schüler P, Huber W, Füzesi L, Becker H: Prognostic factors influencing surgical management and outcome of gastrointestinal stromal tumours. Br J Surg. 2003, 90: 332-339. 10.1002/bjs.4046.CrossRefPubMed Langer C, Gunawan B, Schüler P, Huber W, Füzesi L, Becker H: Prognostic factors influencing surgical management and outcome of gastrointestinal stromal tumours. Br J Surg. 2003, 90: 332-339. 10.1002/bjs.4046.CrossRefPubMed
4.
go back to reference Miettinen M, El-Rifai W, HL Sobin L, Lasota J: Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review. Hum Pathol. 2002, 33: 478-483. 10.1053/hupa.2002.124123.CrossRefPubMed Miettinen M, El-Rifai W, HL Sobin L, Lasota J: Evaluation of malignancy and prognosis of gastrointestinal stromal tumors: a review. Hum Pathol. 2002, 33: 478-483. 10.1053/hupa.2002.124123.CrossRefPubMed
5.
go back to reference Miettinen M, Lasota J: Gastrointestinal stromal tumors; review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med. 2006, 130: 1466-1478.PubMed Miettinen M, Lasota J: Gastrointestinal stromal tumors; review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med. 2006, 130: 1466-1478.PubMed
6.
go back to reference Dematteo RP, Maki RG, Antonescu C, Brennan MF: Targeted molecular therapy for cancer: the application of STI571 to gastrointestinal stromal tumor. Curr Probl Surg. 2003, 40: 144-193. 10.1067/msg.2003.022223.CrossRefPubMed Dematteo RP, Maki RG, Antonescu C, Brennan MF: Targeted molecular therapy for cancer: the application of STI571 to gastrointestinal stromal tumor. Curr Probl Surg. 2003, 40: 144-193. 10.1067/msg.2003.022223.CrossRefPubMed
7.
go back to reference Zwan Van Der SM, Dematteo RP: Gastrointestinal stromal tumors: 5 years later. Cancer. 2005, 104: 1781-1788. 10.1002/cncr.21419.CrossRefPubMed Zwan Van Der SM, Dematteo RP: Gastrointestinal stromal tumors: 5 years later. Cancer. 2005, 104: 1781-1788. 10.1002/cncr.21419.CrossRefPubMed
8.
go back to reference DeMatteo RP: The GIST of targeted cancer therapy: a tumor, a mutated gene (c-kit), and a molecular inhibitor (STI571). Ann Surg Oncol. 2002, 9: 831-839. 10.1007/BF02557518.CrossRefPubMed DeMatteo RP: The GIST of targeted cancer therapy: a tumor, a mutated gene (c-kit), and a molecular inhibitor (STI571). Ann Surg Oncol. 2002, 9: 831-839. 10.1007/BF02557518.CrossRefPubMed
9.
go back to reference Emory TS, Sobin LH, Lukes L, Lee DH, O'Leary TJ: Prognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol. 1999, 23: 82-87. 10.1097/00000478-199901000-00009.CrossRefPubMed Emory TS, Sobin LH, Lukes L, Lee DH, O'Leary TJ: Prognosis of gastrointestinal smooth-muscle (stromal) tumors: dependence on anatomic site. Am J Surg Pathol. 1999, 23: 82-87. 10.1097/00000478-199901000-00009.CrossRefPubMed
10.
go back to reference Berman J, O'Leary TJ: Gastrointestinal stromal tumor workshop. Hum Pathol. 2001, 32: 578-582. 10.1053/hupa.2001.25484.CrossRefPubMed Berman J, O'Leary TJ: Gastrointestinal stromal tumor workshop. Hum Pathol. 2001, 32: 578-582. 10.1053/hupa.2001.25484.CrossRefPubMed
11.
go back to reference Crosby JA, Catton CN, Davis A, Couture J, O'Sullivan B, Kandel R, Swallow CJ: Malignant gastrointestinal stromal tumors of the small intestine: a review of 50 cases from a prospective database. Ann Surg Oncol. 2001, 8: 50-59. 10.1007/s10434-001-0050-4.CrossRefPubMed Crosby JA, Catton CN, Davis A, Couture J, O'Sullivan B, Kandel R, Swallow CJ: Malignant gastrointestinal stromal tumors of the small intestine: a review of 50 cases from a prospective database. Ann Surg Oncol. 2001, 8: 50-59. 10.1007/s10434-001-0050-4.CrossRefPubMed
12.
go back to reference Pierie JP, Choudry U, Muzikansky A, Yeap BY, Souba WW, Ott MJ: The effect of surgery and grade on outcome of gastrointestinal stromal tumors. Arch Surg. 2001, 136: 383-389. 10.1001/archsurg.136.4.383.CrossRefPubMed Pierie JP, Choudry U, Muzikansky A, Yeap BY, Souba WW, Ott MJ: The effect of surgery and grade on outcome of gastrointestinal stromal tumors. Arch Surg. 2001, 136: 383-389. 10.1001/archsurg.136.4.383.CrossRefPubMed
14.
go back to reference Guilhot F: Indications for imatinib mesylate therapy and clinical management. Oncologist. 2004, 9: 271-281. 10.1634/theoncologist.9-3-271.CrossRefPubMed Guilhot F: Indications for imatinib mesylate therapy and clinical management. Oncologist. 2004, 9: 271-281. 10.1634/theoncologist.9-3-271.CrossRefPubMed
15.
go back to reference Schiffer CA: BCR-ABL tyrosine kinase inhibitors for chronic myelogenous leukemia. N Engl J Med. 2007, 357: 258-265. 10.1056/NEJMct071828.CrossRefPubMed Schiffer CA: BCR-ABL tyrosine kinase inhibitors for chronic myelogenous leukemia. N Engl J Med. 2007, 357: 258-265. 10.1056/NEJMct071828.CrossRefPubMed
16.
go back to reference Deininger MW, O'Brien SG, Ford JM, Druker BJ: Practical management of patients with chronic myeloid leukemia receiving imatinib. J Clin Oncol. 2003, 21: 4255-4256. 10.1200/JCO.2003.11.143.CrossRef Deininger MW, O'Brien SG, Ford JM, Druker BJ: Practical management of patients with chronic myeloid leukemia receiving imatinib. J Clin Oncol. 2003, 21: 4255-4256. 10.1200/JCO.2003.11.143.CrossRef
17.
go back to reference Quintas-Cardama A, Kantarjian H, O'Brien S, Garcia-Manero G, Rios MB, Talpaz M, Cortes J: Granulocyte-colony-stimulating factor (filgrastim) may overcome imatinib-induced neutropenia in patients with chronic-phase chronic myelogenous leukemia. Cancer. 2004, 100: 2592-2597. 10.1002/cncr.20285.CrossRefPubMed Quintas-Cardama A, Kantarjian H, O'Brien S, Garcia-Manero G, Rios MB, Talpaz M, Cortes J: Granulocyte-colony-stimulating factor (filgrastim) may overcome imatinib-induced neutropenia in patients with chronic-phase chronic myelogenous leukemia. Cancer. 2004, 100: 2592-2597. 10.1002/cncr.20285.CrossRefPubMed
18.
go back to reference Maki RG: Recent advances in therapy for gastrointestinal stromal tumors. Curr Oncol Rep. 2007, 9: 165-169. 10.1007/s11912-007-0017-0.CrossRefPubMed Maki RG: Recent advances in therapy for gastrointestinal stromal tumors. Curr Oncol Rep. 2007, 9: 165-169. 10.1007/s11912-007-0017-0.CrossRefPubMed
19.
go back to reference Hao CY, Ji JF: Surgical treatment of colorectal cancer: strategies and controversies. Eur J Surg Oncol. 2006, 32: 473-483. 10.1016/j.ejso.2006.02.016.CrossRefPubMed Hao CY, Ji JF: Surgical treatment of colorectal cancer: strategies and controversies. Eur J Surg Oncol. 2006, 32: 473-483. 10.1016/j.ejso.2006.02.016.CrossRefPubMed
20.
go back to reference Kokudo N, Makuuchi M: Current role of portal vein embolization and hepatic artery chemoembolization. Surg Clin North Am. 2004, 84: 643-657. 10.1016/j.suc.2003.12.004.CrossRefPubMed Kokudo N, Makuuchi M: Current role of portal vein embolization and hepatic artery chemoembolization. Surg Clin North Am. 2004, 84: 643-657. 10.1016/j.suc.2003.12.004.CrossRefPubMed
21.
go back to reference Jaeck D, Bachellier P, Nakano H, Oussoultzoglou E, Weber JC, Wolf P, Greget M: One or two-stage hepatectomy combined with portal vein embolization for initially nonresectable colorectal liver metastases. Am J Surg. 2003, 185: 221-229. 10.1016/S0002-9610(02)01373-9.CrossRefPubMed Jaeck D, Bachellier P, Nakano H, Oussoultzoglou E, Weber JC, Wolf P, Greget M: One or two-stage hepatectomy combined with portal vein embolization for initially nonresectable colorectal liver metastases. Am J Surg. 2003, 185: 221-229. 10.1016/S0002-9610(02)01373-9.CrossRefPubMed
22.
go back to reference Kawasaki S, Makuuchi M, Kakazu T, Miyagawa S, Takayama T, Kosuge T, Sugihara K, Moriya Y: Resection for multiple metastatic liver tumors after portal embolization. Surgery. 1994, 115: 674-677.PubMed Kawasaki S, Makuuchi M, Kakazu T, Miyagawa S, Takayama T, Kosuge T, Sugihara K, Moriya Y: Resection for multiple metastatic liver tumors after portal embolization. Surgery. 1994, 115: 674-677.PubMed
23.
go back to reference de Baere T, Roche A, Elias D, Lasser P, Lagrange C, Bousson V: Preoperative portal vein embolization for extension of hepatectomy. Hepatology. 1996, 24: 1386-1391. 10.1002/hep.510240612.CrossRefPubMed de Baere T, Roche A, Elias D, Lasser P, Lagrange C, Bousson V: Preoperative portal vein embolization for extension of hepatectomy. Hepatology. 1996, 24: 1386-1391. 10.1002/hep.510240612.CrossRefPubMed
24.
go back to reference Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K, Harihara Y, Takayama T: Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997, 26: 1176-1181.PubMed Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K, Harihara Y, Takayama T: Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997, 26: 1176-1181.PubMed
25.
go back to reference Madoff DC, Abdalla EK, Vauthey JN: Portal vein embolization in preparation for major hepatic resection: evolution of a new standard of care. J Vasc Intrv Radiol. 2005, 16: 770-790. Madoff DC, Abdalla EK, Vauthey JN: Portal vein embolization in preparation for major hepatic resection: evolution of a new standard of care. J Vasc Intrv Radiol. 2005, 16: 770-790.
Metadata
Title
A multidisciplinary approach for the treatment of GIST liver metastasis
Authors
Pejman Radkani
Marcelo M Ghersi
Juan C Paramo
Thomas W Mesko
Publication date
01-12-2008
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2008
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/1477-7819-6-46

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